Therapy strategies to defeat prostate cancer heterogeneity

Metastatic prostate cancer heterogeneity is a multifactorial spatiotemporally dynamic process that leads to disease progression, emergence of treatment resistance and eventual treatment failure. Understanding of the root causes of tumor heterogeneity is the key to develop strategies for more effective therapies. The intra-patient (inter-tumor), and inter-patient heterogeneity demands combinatorial treatment strategies anchored to patient-specific disease biology that can successfully tackle the complexity of the disease in the hopes of overcoming the biological barriers to cancer control. The aim of this article is to briefly review the elements of metastatic prostate cancer heterogeneity and propose approaches to tackle the ensuing therapeutic challenges to achieve durable clinical efficacy in the context of radiopharmaceutical therapy.